In the United States, over 300,000 individuals over the age of 65 suffer from distal radius fractures each year. However, despite over 200 years of experience treating this injury, management of elderly distal radius fracture is still controversial. Closed reduction and casting is a nonsurgical technique that is commonly used, but osteoporotic fractures often collapse and redisplace. The three currently applied surgical techniques include closed reduction and percutaneous pinning, external fixation 1 percutaneous pinning, and volar locking plating fixation. Despite some evidence that elderly patients experience good outcomes following plate fixation, there are no randomized controlled clinical trials to demonstrate that this technique is superior to the other, simpler approaches. For this clinical trial planning grant, we propose a 10 site randomized controlled trial comparing these three surgical techniques to define their outcomes in treating elderly distal radius fractures, to identify predictors of functional outcomes and to perform an economic analysis to determine the dominant treatment strategy based on consideration of cost and utility from the societal perspective. This planning grant is necessary to undertake the coordination of all 10 sites to ensure a high level of data quality.